Eligibility Representative- Evernorth- Remote

Eligibility Representative-Evernorth (CarePathRx)At Evernorth Health Services, we believe access to care starts with clarity, compassion, and trust. As an Insurance Eligibility Representative, you play a critical role in helping patients understand their coverage and financial responsibility so they can focus on their health with confidence. Supporting CarepathRx within our Pharmacy and Care Delivery organization, you will partner with patients, payers, and care teams to ensure accurate insurance verification and a smooth reimbursement experience. This role is ideal for someone who is detail-oriented, patient-focused, and motivated to grow their expertise in specialty pharmacy and infusion services.Schedule: MondayFriday, 8:00 AM6:00 PM EST (rotating shifts)Key ResponsibilitiesDeliver accurate and timely insurance eligibility verification to support patient access to specialty pharmacy and infusion servicesTranslate insurance benefits into clear cost estimates and coverage explanations for patients and care teamsCreate and maintain complete, accurate patient profiles, including demographics, insurance details, and authorization statusGenerate financial responsibility letters and review benefits with patients by phone in a supportive, easy-to-understand mannerSecure prior authorizations and required payer documentation to prevent delays in careCoordinate financial assistance applications, payment agreements, and required waiversMonitor reimbursement activity, identify issues early, and assist with research to support resolutionCollaborate with internal partners to ensure a seamless patient and client experienceMaintain productivity, quality, and accuracy standards while managing multiple prioritiesDemonstrate accountability, follow-through, and pride in delivering reliable, high-quality workContribute to continuous improvement by sharing insights and supporting efficient reimbursement workflowsQualificationsRequired QualificationsHigh school diploma or GEDMinimum 1 year of experience in insurance verification, prior authorization, or related reimbursement work within a healthcare settingWorking knowledge of medical terminologyProficient computer skills, including Microsoft Office productsStrong math skills with attention to detailClear written and verbal communication skillsStrong organization and time management abilitiesPreferred QualificationsExperience navigating payer websites and eligibility systemsUnderstanding of coordination of benefitsKnowledge of pharmacy versus medical benefit payersFamiliarity with prior authorization requirements and plan formulariesExperience supporting specialty pharmacy or infusion servicesAbout CarepathRx at EvernorthAs part of Evernorth Health Services, CarepathRx partners with hospitals and health systems to deliver specialty pharmacy and infusion services that improve outcomes and elevate the patient experience. Our teams are ambitious, compassionate experts committed to learning, growing, and making healthcare simpler and more human every day.This role is also anticipated to be eligible to participate in an annual bonus plan.At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.